Overview

Pearly penile papules (also known as “hirsuties coronae glandis,” “hirsutoid papillomas,” or simply “PPPs”) are small protusions that form a ridge on the glans, or “head” of the human penis. The papules most commonly appear as one or several rows of small, pearly or flesh-colored, smooth, dome-shaped bumps situated circumferentially around the corona of the glans. They may range in size from less than 1 millimeter to 3 millimeters in length.

Although they are sometimes confused with HPV warts, pearly penile papules are a normal, entirely harmless anatomical variation that cannot be transmitted between individuals. They are not caused by sexual activity or lack of hygiene and they are not infectious or contagious, unlike genital warts. They are not malignant or pre-malignant.1 It is important to differentiate harmless conditions like pearly penile papules and Fordyce spots from actual sexually transmitted infections, as males with pearly penile papules often feel stigmatized by potential sexual partners who do not understand that the condition poses no risk to either person's health. Pearly penile papules are a common skin variation and are estimated to be present in roughly a quarter of adult males, with actual percentages reported between 8 and 43 percent.2 For reasons unknown, pearly penile papules appear more commonly in males who are uncircumcised.

Glans penis with pearly penile papules.

Symptoms

Not counting the appearance of the papules themselves, pearly penile papules are an entirely asymptomatic condition.

Causes and Risk Factors

Medical science has yet to determine the actual physiological cause for pearly penile papules, although it is theorized that the bumps are merely vestigial remnants of sensitive penile protusions known as “penile spines” found in the same location in other primates.3 In those species that retain the full expression of penile spines, the spines contribute to sexual pleasure and quicker orgasms. This effect is not observed in human males, as pearly penile papules do not appear to have any physiological role in one's penile sensitivity or sexual performance. Race and being uncircumcised are suggested risk factors in developing pearly penile papules. Several reports suggest an increased incidence in uncircumcised versus circumcised men (22% vs. 12%, respectively). One study found a greater incidence in black versus white men, in those circumcised (21% vs. 7%, respectively) and uncircumcised (44% vs. 33% respectively).2

Prognosis

Although age is not a clear defining factor in the onset of pearly penile papules, most males report onset of pearly penile papules between 20 and 40 years of age. There have been many cases reported of onset in males shortly after reaching puberty.4 Because pearly penile papules can be so small, some men do not even realize they have them until much later in life.

Diagnosis

A diagnosis of pearly penile papules can be obtained from a dermatologist or similarly trained physician. The differential diagnosis (elimination of possible alternative conditions) includes condyloma acuminata (genital warts), molluscum contagiosum, ectopic sebaceous glands, and lichen nitidus. Condyloma acuminata are most important to rule out because unlike pearly penile papules, they are less uniform in shape and size, appear to be more wart-like, and might change in appearance over time.5 In addition, genital warts are not typically arranged in neat circular rows surrounding the corona of the glans, as are pearly penile papules. Lesions of molluscum contagiosum tend to be larger in size and marked by navel-like depressions, sometimes with a pink hue.

Ectopic sebaceous glands and lichen nitidus are both commonly located on the penile shaft and can thus be eliminated from diagnosis. Furthermore, ectopic sebaceous glands are yellowish in color and can often discharge a cheese-like material. On the other hand, lesions of lichen nitidus tend to be flat-topped and are often polygonal in shape. In cases in which the diagnosis is uncertain, a biopsy can be performed, as pearly penile papules have a unique microscopic anatomy.5

A microscopic view of a single pearly penile papule.

Treatment

Because pearly penile papules pose no health risk, treatment is typically only advised if the protrusions are causing psychological stress. Before beginning any form of treatment, it is essential that patients receive a proper diagnosis to avoid the cost and hassle of undergoing a possibly ineffective and unnecessary removal procedure.

Surgical treatment for pearly penile papules involves the surgical removal of each papule on the penis, an operation which requires hospitalization and the administration of anesthesia. Under no circumstances should an individual attempt to perform surgery on his or her own penis. These treatments include (in order of effectiveness):

Carbon Dioxide Laser Surgery

The surgeon uses highly targeted carbon dioxide lasers to produce beams of infrared light, which disintegrate the papule tissues at the molecular level. This method is the safest and most effective surgical option available for the treatment of pearly penile papules.

Radiosurgery

The surgeon uses high dose radiation to selectively ionize the tissue, producing free radicals that are deleterious to the cells. When used to remove pearly penile papules, this procedure is more accurate than excisional or Hyfrecator surgery, but less so than carbon dioxide laser surgery.

Cryosurgery or Freezing

The papules are cooled to extreme low temperatures using liquid nitrogen until they fall off.

Excisional Surgery

Using a scalpel or lancet, the surgeon cuts and removes each papule one by one. This method is generally less accurate than others and may result in damage to the surrounding tissues. Manageable pain is to be expected during the recovery stage.

Electro-dessication with Curettage using Hyfrecator

The papules are dessicated (put in a state of extreme dryness) with electricity, after which the residual tissues are removed by scraping or scooping with surgical instruments. This method can be painful unless the patient is anesthetized and may result in permanent scarring. Manageable pain during recovery is to be expected.

Photos of a male's penis taken before and after a PPP-removal surgery.

In addition to the aforementioned surgical treatments, individuals with pearly penile papules have employed a number of holistic home remedies of variable medical efficacy. These treatments nearly always include directly applying liquid(s), gel(s), or paste(s) to the papules for weeks at a time until the bumps appear to shrink in size. Commonly applied ointments include toothpaste, eucalyptus oil, lemon juice, and castor oil.6 Careful research is highly recommended before beginning any type of holistic treatment.

Toothpaste has been used as a home remedy for pearly penile papules

Coping

Males with pearly penile papules commonly experience a great deal of anxiety and psychological stress concerning the appearance of their penis. Males with pearly penile papules may feel self-conscious and inferior to those who do not have the condition. These feelings may manifest in sexual difficulty, low self-esteem, and general problems with intimacy.

Because the condition is often stigmatized, males with pearly penile papules might feel that surgical removal is their only salvation from a life of sexual embarrassment. While surgical removal may certainly provide relief for some, many cannot afford the cost of effective surgeries and might instead attempt to treat their papules using unsafe methods at home, sometimes worsening the appearance of their penis. Others will spend exorbitant amounts of money on scam products or services that claim to remove one's papules in “3 days or less,” as one web ad claims.

The best advice for an individual with pearly penile papules for whom surgery is not a viable consideration is simply to love your body. Pearly penile papules are not going to scare away a partner who genuinely cares for you. If you happen to encounter such a person, he or she was certainly not worth the time investment. In the meantime, accept that you are among a select group of rare anatomical variants and take pride in being special. Some partners of individuals with pearly penile papules even claim that the papules enhance their receptive sexual sensations. While it is understandable to feel some anxiety over a physical “abnormality,” especially when it affects such a delicate region of the body, acceptance and respect for oneself is inarguably the healthiest (and most cost-effective) mode of treatment.

A typical web ad targeting pearly penile papules as the cause for a lost sex life.

Prevention

There is no known method of preventing pearly penile papules. Since pearly penile papules appear more common in uncircumcised males, it is possible that circumcision may reduce the likelihood of onset.